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Home > Breastfeeding > The Normal Course of Breastfeeding Breastfeeding and FertilityBy Kelly Bonyata, BS, IBCLC
The Exclusive Breastfeeding method of birth control is also called the Lactational Amenorrhea Method of birth control, or LAM. Lactational amenorrhea refers to the natural postpartum infertility that occurs when a woman is not menstruating due to breastfeeding. Many mothers receive conflicting information on the subject of breastfeeding and fertility. Myth #1 – Breastfeeding cannot be relied upon to prevent pregnancy. Myth #2 – Any amount of breastfeeding will prevent pregnancy, regardless of the frequency of breastfeeding or whether mom’s period has returned. Exclusive breastfeeding has in fact been shown to be an excellent form of birth control, but there are certain criteria that must be met for breastfeeding to be used effectively. Exclusive breastfeeding (by itself) is 98-99.5% effective in preventing pregnancy as long as all of the following conditions are met:
How can I maximize my natural period of infertility?Timing for the return to fertility varies greatly from woman to woman and depends upon baby's nursing pattern and how sensitive mom's body is to the hormones involved in lactation.
You can achieve higher effectiveness by practicing ecological breastfeeding:
If you practice ecological breastfeeding:
While it is possible for a nursing mom to become pregnant while she is breastfeeding and before she has her first menstrual period, it is rare. Most moms do not get pregnant until after their first period (often referred to as the "warning period"). Even after that, while some can become pregnant the first cycle, others will require months of cycles before pregnancy can occur. Still others (this is quite uncommon) may not be able to become pregnant until complete weaning has occurred.
Several studies have indicated that fertility and ovarian activity return step by step (Ellison 1996, p. 326-327):
It is possible to have one or (occasionally) more periods before you start ovulating. In this case, menstruation begins during the first stage of the return to fertility --before ovulation returns. Cycles without ovulation are most common during the first six months postpartum. For other mothers, the first menstruation is preceded by ovulation - a longer period of lactational amenorrhea increases the likelihood that you will ovulate before that first period. A very small percentage of women will become pregnant during their first postpartum ovulation, without having had a postpartum period. Per fertility researcher Alan S. McNeilly, this "is rare and in our experience is related to a rapid reduction in suckling input." It is not uncommon for breastfeeding mothers to report cyclical cramping or PMS-type symptoms - symptoms of an oncoming period without the period - for weeks or even months before their period returns. When this happens, the body is probably "gearing up" for the return of menstruation, but breastfeeding is still delaying the return of fertility. The amount of time that it takes for the transition to full fertility varies from woman to woman. In general, the earlier that your menses return, the more gradual the return to full fertility.
Probably not. If you are still transitioning to full fertility (as discussed above), breastfeeding may affect the success of implantation. Once implantation is successful, breastfeeding should not affect a healthy pregnancy (see A New Look at the Safety of Breastfeeding During Pregnancy for more information). If your periods have come back and settled into a regular pattern, it is likely that breastfeeding is no longer affecting your fertility. Many moms can conceive without deliberately changing their toddler's nursing patterns. There is no "magic" threshold of breastfeeding that will allow you to conceive -- every mother is different. Some moms need to stretch out nursing frequency and/or shorten nursing sessions to make it easier to conceive -- babies naturally do this themselves as they get older, so one of your options is simply to wait a bit. Changes that are more abrupt tend to bring fertility back faster (e.g., cutting out one nursing session abruptly, rather than gradually decreasing nursing time at that session) --even if you continue to breastfeed a great deal-- this is why many mothers experience the return of fertility when their child sleeps through the night or starts solid foods. If you decide to make changes to your nursing pattern, the time of day that you make the change (e.g., cutting out or shortening a nighttime nursing session as opposed to a daytime nursing session) should not make that much of a difference. Current research indicates that nursing frequency and total amount of time at the breast per 24 hours are the most important factors, rather than the time of day that the suckling occurs. A few moms do find it impossible to conceive while nursing, but this is not at all common. Many mothers wonder whether breastfeeding will affect the reliability of pregnancy tests. It does not -- pregnancy tests measure the amount of the hormone hCG (human chorionic gonadotropin) in blood or urine, and hCG levels are not affected by breastfeeding. The developing placenta begins releasing hCG upon implantation; a pregnancy can generally be detected with a pregnancy test within 7-14 days after implantation. For more information, see Getting Pregnant While Breastfeeding by Hilary Flower. When you do get pregnant while breastfeeding, what next? See Nursing During Pregnancy & Tandem Nursing for more information.
Page last modified:
05/09/2007
References and Additional Resources
Birth Control and
Breastfeeding @ Getting Pregnant While Breastfeeding by Hilary Flower Menstruation and Breastfeeding by Becky Flora, IBCLC Bleeding at 4 weeks postpartum by Debbi Donovan, IBCLC Breastfeeding and Menstruation, Birth Control and Vaginal Dryness by Paula Yount Can I get pregnant while I am breastfeeding? LLL FAQ The Garden of Fertility by Katie Singer Breastfeeding and Birth Control by Anne Smith, IBCLC Breastfeeding and Fertility by Sherri Hedberg, IBCLC Breastfeeding and Fertility by Katherine Dettwyler, PhD Toddler Tips: Fertility and Night Nursing from NEW BEGINNINGS, Vol. 18, No. 1, January-February 2001 pp. 23-25 Trying to Conceive while Breastfeeding support board at ParentsPlace.com How does nursing impact fertility charting? by Toni Weschler Ask the Fertility Expert columns by Toni Weschler Is a pregnancy test accurate when nursing? by Debbi Donovan, IBCLC Early return of period with nursing by Debbi Donovan, IBCLC Ask the Lactation Consultant: Fertility and Sexuality by Debbi Donovan, IBCLC Taking Charge of Your Fertility website - check out the library and the discussion boards. Campino C, Torres C, Rioseco A, Poblete A, Pugin E, Valdes V, Catalan
S, Ellison, PT. Breastfeeding, Fertility, and Maternal Condition. In: Stuart-Macadam P, Dettwyler KA, ed. Breastfeeding: Biocultural Perspectives. Hawthorne, NY: Aldine de Gruyter, 1995:305-345. Eslami SS, Gray RH, Apelo R, Ramos R. The reliability of menses to indicate the return of ovulation in breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50. Gray RH, Campbell OM, Apelo R, Eslami SS, Zacur H, Ramos RM, Gehret JC, Labbok MH. Risk of ovulation during lactation. Lancet. 1990 Jan 6;335(8680):25-9. Howie PW, McNeilly AS, Houston MJ, Cook A, Boyle H. Fertility after childbirth: infant feeding patterns, basal PRL levels and post-partum ovulation. Clin Endocrinol (Oxf). 1982 Oct;17(4):315-22. Several papers and discussions on fertility and breastfeeding from The United Nations University Press Food and Nutrition Bulletin Volume 17, Number 4, December 1996. What is the contraceptive effect of breastfeeding my baby? from the Managing Contraception website The Garden of Fertility by Katie Singer Breastfeeding and Childspacing by Dr. William Sears What is LAM?. Did you know that exclusive breastfeeding can prevent pregnancy for up to six months? This site answers your questions! Natural Child Spacing and Breastfeeding by Jen O'Quinn, from LEAVEN, Vol. 34 No. 6, December 1998 - January 1999, p. 128. The Lactational Amenorrhea Method (LAM): Another Choice for Mothers by Miriam H. Labbok, MD, MPH, from Breastfeeding Abstracts, August 1993, Volume 13, Number 1, pp. 3-4. Fact Sheet on the Lactational Amenorrhea Method (LAM) from the LINKAGES Project (PDF version) Also available in French and Spanish from the LINKAGES website. Breastfeeding and LAM: Beyond Conventional Approaches by Ted Greiner, PhD Exclusive Breastfeeding/Lactational Amenorrhea Method of Birth Control. from EngenderHealth.org Managing Fertility Naturally During Breastfeeding. From the Billings Ovulation Method of Natural Family Planning. Continue on to their home page for more info on the method. Taylor, H. William, et al. Continuously Recorded Suckling Behaviour and Its Effect on Lactational Amenorrhoea. J Biosoc Sci. 1999;31: 289-310. Valdes V, Labbok MH, Pugin E, Perez A. The efficacy of the lactational amenorrhea method (LAM) among working women. Contraception. 2000 Nov;62(5):217-9. Breastfeeding as a means to fertility regulation: reviewing the evidence. Progress in Reproductive Health Research. 2000;55:1-7. Your Fertility Signals by Merryl Winstein Taking Charge of Your Fertility by Toni Weschler Breastfeeding and Natural Child Spacing by S.K. Kippley A Pocket Guide to Managing Contraception by Robert Anthony Hatcher, M.D., MPH, et. al. includes accurate information on LAM and other methods of contraception Ellison, Peter T. "Breastfeeding, Fertility and Maternal Condition," from Breastfeeding: Biocultural Perspectives (Stuart-Macadam, P. and Dettwyler, K., ed.), New York: Walter de Gruyter, Inc., 1995, p. 305-345. Mohrbacher, N. and Stock, J. "Breastfeeding, Fertility, and Contraception" from The Breastfeeding Answer Book, Revised ed. Schaumburg, Illinois: La Leche League International, 1997, pp.356-363. Valdés V, Labbok MH, Pugin E, and Perez A. The efficacy of the lactational amenorrhea method (LAM) among working women. Contraception, 01 Nov 2000; 62(5): 217-9. |
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